FIG. 3.

Scanning electron microscopic observation of TM healing after grafting. The medial aspect of TMs was observed with SEM (A). SEM confirmed the attachment of SFS and ACS to the perforation margin throughout the healing process. TM epithelial cells were seen to have migrated to the medial surface of SFS on day 3 (B-a;×500) and ACS on day 5 (B-b;×500). TMs grafted with ACS and SFS had healed on day 9, where the medial surface of neo-membranes was smooth. Paper patch showed partial detachment from the TM surface on day 3. Exudate and inflammatory cell infiltration was evident at the perforation site on day 5 (B-c;×150). Gelfoam showed early disintegration with a majority of Gelfoam dissolving by day 3 (B-d;×100). At 14 days, the healed TMs in paper patch and Gelfoam groups showed some scarring (white arrows). In the control group, a rolled perforation edge in the unhealed TM was evident at 9 days (B-e;×150), and the TM healed by 14 days with an obvious scar (white arrow). Tears in the TMs were artefacts during the drying process. Asterisks indicate scaffolds; white arrowheads indicate perforation margin. M, handle of malleus; E, epithelial cells. Scale bar: 500 μm.